Key result
Revascularization, MCS, and shock teams remain essential for managing infarct-related cardiogenic shock.
Why the study?
Current recommendations for culprit lesion-only revascularization in AMI-CS are based on recent randomized evidence with limitations and conflicting non-randomized data, while the role of MCS devices continues to evolve.
What is the optimal revascularization strategy and role of mechanical circulatory support in patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease?
What is the optimal revascularization strategy and role of mechanical circulatory support in patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease?
This review highlights the ongoing debate between culprit-only and complete revascularization in AMI-CS, emphasizing the potential role of early mechanical circulatory support and shock teams.
Supports shock team integration in infarct-related cardiogenic shock; leaves open optimal revascularization and MCS strategies for RCTs.
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is a life-threatening condition frequently encountered in patients with multivessel coronary artery disease (CAD). Despite prompt revascularization, in particular, percutaneous coronary intervention (PCI), and therapeutic and technological advances, the mortality rate for patients with CS related to AMI remains unacceptably high. Differently form a hemodynamically stable setting, a culprit lesion-only (CLO) revascularization strategy is currently suggested for AMI-CS patients, based on the results of recent randomized evidence burdened by several limitations and conflicting results from non-randomized studies. Furthermore, mechanical circulatory support (MCS) devices have emerged as a key therapeutic option in CS, especially in the case of their early implantation without delaying revascularization and before irreversible organ damage has occurred. We provide an in-depth review of the current evidence on optimal revascularization strategies of multivessel CAD in infarct-related CS, assessing the role of different types of MCS devices and highlighting the importance of shock teams and medical care system networks to effectively impact on clinical outcomes.
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Masiero et al. (2022) conducted a review in Acute myocardial infarction complicated by cardiogenic shock with multivessel coronary artery disease. Optimal revascularization strategies and mechanical circulatory support was evaluated. A review of current evidence highlights the importance of optimal revascularization strategies, mechanical circulatory support devices, and shock teams in managing infarct-related cardiogenic shock.
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